Transcript Oral Health for Children in Health Reform Discussions

Oral Health for Children in
Health Reform Discussions
Meg Booth
Executive Director
Children’s Dental Health Project
February 28, 2017
Children’s Dental Health Project
In 1997, Children’s Dental Health Project was created to
advance innovative policy solutions so that no child suffers
from tooth decay. We are driven by the vision that all children
will achieve optimal oral health in order to reach their full
potential.
CDHP Goals:
» Prevent childhood tooth decay.
» Ensure all children have affordable comprehensive
care that improves their oral health.
» Measure for the oral health we want for our children.
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Key Messages
• Oral health is critical to
children’s overall health.
• Preventive oral health care
has a lifelong impact on
children and their families.
• Dental care remains
vulnerable when not
specifically addressed in
policy decisions.
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Oral Health vs Tooth Decay
Tooth Decay Is Preventable
• Dental caries is the disease that causes cavities/tooth decay
• Caries is the #1 chronic condition in childhood
• Dental caries is an infectious disease transmitted primarily from
mother-to-child through bacteria in saliva
Dental Caries Is a Progressive Chronic Disease
• 23% of 2-5 year olds have experienced a cavity, and 56% of kids
ages 6-8
• 53%-79% of children treated in the OR for severe caries will
experience new cavities within 2 yrs.
• Children with cavities in baby teeth are 3x more likely for adult decay
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The High Cost of Poor Oral Health
Poor Oral Health Hurts School Performance
•
•
Children with poor oral health 3x more likely to miss school
Children with poor oral health are 4x more likely to earn lower grades
Poor Oral Health is Costly
•
The costs of treating children for rampant tooth decay in a Denver
hospital (2014) ranged from $10,000 to $15,000 per case.
Poor Oral Health Limits Economic Success
•
•
Good oral health may increase annual earnings by up to 5%
Missing and visibly decayed teeth harm employment opportunities
Poor Oral Health Impacts our National Security
•
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In 2012, 62% of U.S. Army new recruits were not immediately
deployable because of a significant dental issue
S.L. Jackson et al., “Impact of poor oral health on children’s school attendance and performance,” Amer J of Public Health, Oct. 2011; H. Seirawan et al., “The impact of oral health
on the academic performance of disadvantaged children,” Amer J of Public Health, Sept. 2012. Estimated cost by Denver Health official, Colorado Public Radio (2015). Glied,
Sherry, and Neidell, Matthew. "The economic value of teeth." J of Human Resources 45.2 (2010): 468-496. Hyde S, Satariano WA, Weintraub JA.” Welfare dental intervention
improves employment & quality of life.” J Dent Res. 2006; 85(1):79-84. Bipartisan Policy Center. 2012. Lots to lose: How America’s health and obesity crisis threatens our Economic
Future. Bipartisan Policy Center.
Medicaid Dental for Children
l
EPSDT dental care minimum standard:
“relief of pain and infections, restoration of teeth,
and maintenance of dental health.”
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l
Each state Medicaid program
determines its own dental
periodicity schedule in consultation
with recognized dental
organization(s).
l
Oral health benefits are stabilized
as part of the EPSDT package, but
allows states to determine the
design base on their unique needs.
Medicaid Innovation in Oral Health
Innovation in Medicaid dental programs include:
• Adoption of risk assessment codes to improve care
and accountability (AZ, CT, DE, IL, MT, NJ, TN, TX)
• Use of new pharmaceuticals to stop decay with highrisk patients
• Use of tele-dentistry and allied health professionals
(CA, CO, HI)
• Integration of oral health services into medical and
social services settings (nationally)
• Incorporation of oral health into accountable care
organizations (OR, possibly MA)
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Oral Health Innovation in Medicaid
Oral health payment and service delivery innovation is
happening:
• 16 states: Perinatal and Infant Oral Health Quality
Improvement initiative
• 4 awards: CMMI Health Care Innovation Awards
• 3 states: CHIPRA Quality Demonstration grants
• 1 state: California 5-year Dental Transformation
Initiative
• Multiple states: State Innovation Models (SIM)
• Coming soon: CMS IAP Medicaid Payment Reform
in Children’s Oral Health
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Children’s Health Insurance Program (CHIP)
• Created in 1997, CHIP did not
include a dental benefit until 2010
(CHIPRA 2009) – which made the
benefit vulnerable to being cut in
difficult budget years.
• States determine the structure and
benchmarks that meet the basic
benefit standards.
• The program was reauthorized in
ACA until 2019, however funding
ends Sept. 2017.
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Dental Coverage Improves Health
Medicaid and CHIP enrolled children to see dental
providers on par with their privately insured peers
• Publicly insured children receive dental care at equivalent
or better rates than privately insured children – adjusted for
family income (Shariff, J. et. al)
• In some states, Medicaid children are more likely to access
dental care than their privately-insured peers.
Children with Medicaid/CHIP with dental care have fewer
unmet dental needs
• Public insurance is associated with fewer unmet dental
needs, particularly for children who had visited a dentist in
the last 12 months
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Oral Health is a Smart Investment
• The investments in children’s dental coverage
is paying off with reductions in disease and
decreasing treatment costs.
• Children that have benefited from public dental
programs will be transitioning into the
workforce with fewer oral health problems and
lower dental care needs.
• CMS and Congress should encourage state
innovation under current system to further
improve oral health.
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Contact Information
Meg Booth, MPH
Executive Director
E: [email protected]
P: 202.417.3598
www.cdhp.org
www.endcavities.org
@Teeth_Matter
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